Background. Studies have indicated possible links between substance use disorder and other psychiatric disorders and suggested a high prevalence of unmet mental health needs amongst those with substance use disorders compared to the general population. Method. The study investigated the mental health needs of adolescents attending a substance misuse service. Mental health needs were assessed using the Strengths and Difficulties Questionnaire, the Conners screen for Attention Deficit Hyperactivity Disorder and a brief measure ascertaining demographics, drug use, and the service required by young people. Results. Young people were found to have higher than normal rates of mental health problems; this was not reflected in referral rates from the service. Conclusion. The findings are relevant to both commissioners and service providers. There is a need for integration between mental health services and those working with young substance users to provide a model of care that caters for dual diagnosis. Furthermore, offering mental health training to teams working with drug-using young people is recommended. 1. Background Healthcare provision in the United Kingdom is at an important junction; the White Paper Healthy Lives Healthy People (2010) emphasises the need to ensure that resources are used effectively, while at the same time embracing the culture of service user feedback. It is of note that the White Paper does not comment on developmental disorders and we are keen to reduce the separation between the evolving evidence base regarding developmental disorders and key national policies. We suggest that adolescent mental health clinicians are ideally placed to elucidate the relationship between mental health and substance use; NICE [1] notes that there is a “lack of evidence on how to prevent substance misuse among particular groups of vulnerable and disadvantaged children and young people,” including “those with mental health problems.” This study sought to address this deficit. Finally, the Government document “Drugs: protecting families and communities” emphasises the need for “producing guidance for commissioners, service providers and CAMHS to ensure that improved needs assessment and treatment planning processes are in place in all areas.” Furthermore, as envisaged in the National Service Framework for Children, young people and maternity services (2007), commissioners in Manchester are keen to understand the unmet needs of vulnerable, high-risk adolescents, as exemplified by the young people using the voluntary drug and alcohol support service in
References
[1]
National Institute for Health and Clinical Excellence, “Community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people,” Public health intervention guidance; no. 4, National Institute for Health and Clinical Excellence, London, UK, 2007.
[2]
H. M. Government, “Drugs: Protecting Families and Communities Action Plan,” 2008, http://www.bdat.org.uk/documents/drug-action-plan-2008-2011.pdf.
[3]
Institute of Alcohol Studies, “Adolescents and Alcohol,” 2010, http://www.ias.org.uk/resources/factsheets/factsheets.html.
[4]
S. Pudney, “The road to ruin? Sequences of initiation into drug use and offending by young people in Britain,” Home Office Research Study 253.Home Office Research, Development and Statistics Directorate, 2002, http://webarchive.nationalarchives.gov.uk/20110218135832/http://rds.homeoffice.gov.uk/rds/pdfs2/hors253.pdf.
[5]
OFSTED, Drug Education in Schools: An Update, Office of Her Majesty’s Chief Inspector of Schools, London, UK, 2000.
[6]
Changing Habits North West Dual Diagnosis Intelligence Report, “Informing the Commissioning, Management and Provision of Integrated Service Provision for Dual Diagnosis Treatment Populations,” Care Services Improvement Partnership, North West Development Centre, 2007, http://www.nmhdu.org.uk/silo/files/changing-habits.pdf.
[7]
D. W. Brook, J. S. Brook, C. Zhang, and J. Koppel, “Association between attention-deficit/hyperactivity disorder in adolescence and substance use disorders in adulthood,” Archives of Pediatrics and Adolescent Medicine, vol. 164, no. 10, pp. 930–934, 2010.
[8]
B. S. G. Molina and W. E. Pelham, “Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD,” Journal of Abnormal Psychology, vol. 112, no. 3, pp. 497–507, 2003.
[9]
R. A. Barkley, M. Fischer, L. Smallish, and K. Fletcher, “Young adult follow-up of hyperactive children: antisocial activities and drug use,” Journal of Child Psychology and Psychiatry and Allied Disciplines, vol. 45, no. 2, pp. 195–211, 2004.
[10]
R. A. Chambers, J. R. Taylor, and M. N. Potenza, “Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability,” American Journal of Psychiatry, vol. 160, no. 6, pp. 1041–1052, 2003.
[11]
T. E. Wilens, S. V. Faraone, J. Biederman, and S. Gunawardene, “Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature,” Pediatrics, vol. 111, no. 1, pp. 179–185, 2003.
[12]
T. E. Wilens, J. Adamson, S. Sgambati et al., “Do individuals with ADHD self-medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD,” American Journal on Addictions, vol. 16, no. 1, supplement, pp. 14–23, 2007.
[13]
C. E. Sartor, M. T. Lynskey, A. C. Heath, T. Jacob, and W. True, “The role of childhood risk factors in initiation of alcohol use and progression to alcohol dependence,” Addiction, vol. 102, no. 2, pp. 216–225, 2007.
[14]
H. Green, A. McGinnity, H. Meltzer, T. Ford, and R. Goodman, “Mental health of children and young people in Great Britain,” 2004, http://www.ons.gov.uk/ons/index.html.
[15]
L. Hackett, L. Theodosiou, C. Bond, C. Blackburn, F. Spicer, and R. Lever, “Understanding the mental health needs of primary school children in an inner-city local authority,” Pastoral Care in Education, vol. 28, no. 3, pp. 205–218, 2010.
[16]
R. Goodman, “The strengths and difficulties questionnaire: a research note,” Journal of Child Psychology and Psychiatry and Allied Disciplines, vol. 38, no. 5, pp. 581–586, 1997.
[17]
R. Goodman, T. Ford, H. Simmons, R. Gatward, and H. Meltzer, “Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample,” British Journal of Psychiatry, vol. 177, pp. 534–539, 2000.
[18]
R. Goodman, “Psychometric properties of the strengths and difficulties questionnaire,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 40, no. 11, pp. 1337–1345, 2001.
[19]
C. K. Conners, K. C. Wells, J. D. A. Parker, G. Sitarenios, J. M. Diamond, and J. W. Powell, “A new self-report scale for assessment of adolescent psychopathology: factor structure, reliability, validity, and diagnostic sensitivity,” Journal of Abnormal Child Psychology, vol. 25, no. 6, pp. 487–497, 1997.
[20]
C. Keith Conners, G. Sitarenios, J. D. A. Parker, and J. N. Epstein, “Revision and restandardization of the Conners Teacher Rating Scale (CTRS-R): factor structure, reliability, and criterion validity,” Journal of Abnormal Child Psychology, vol. 26, no. 4, pp. 279–291, 1998.
[21]
C. K. Conners, “Clinical use of rating scales in diagnosis and treatment of attention- deficit/hyperactivity disorder,” Pediatric Clinics of North America, vol. 46, no. 5, pp. 857–870, 1999.
[22]
R. J. Diclemente, M. S. Ruiz, and J. M. Sales, “Barriers to adolescents' participation in HIV biomedical prevention research,” Journal of Acquired Immune Deficiency Syndromes, vol. 54, no. 1, supplement, pp. S12–S17, 2010.
[23]
B. Minty and C. Anderson, “Non-attendance at initial out-patient appointments at a hospital-based child psychiatric clinic,” Clinical Child Psychology and Psychiatry, vol. 9, no. 3, pp. 403–418, 2004.
[24]
S. Sprich, J. Biederman, M. H. Crawford, E. Mundy, and S. V. Faraone, “Adoptive and biological families of children and adolescents with ADHD,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 39, no. 11, pp. 1432–1437, 2000.
[25]
J. P. Allen, J. Chango, D. Szwedo, M. Schad, and E. Marston, “Predictors of susceptibility to peer influence regarding substance use in adolescence,” Child Development, vol. 83, no. 1, pp. 337–350, 2012.
